Healthcare Provider Details

I. General information

NPI: 1003070061
Provider Name (Legal Business Name): GRACE FORTES MONIS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIVINA GRACE FORTES MONIS

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 V ST UC DAVIS MEDICAL CENTER, PATHOLOGY
SACRAMENTO CA
95817-1445
US

IV. Provider business mailing address

4400 V ST UC DAVIS MEDICAL CENTER, PATHOLOGY
SACRAMENTO CA
95817-1445
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7347
  • Fax:
Mailing address:
  • Phone: 916-734-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA134462
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA134462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: